Millions of individuals in the United States require long-term treatment with an oral anticoagulant. For decades, vitamin K antagonists were the only oral option available; however, they have a number of well-known limitations. Introduction of the direct oral anticoagulants (DOACs) has long been considered a major therapeutic advance, largely because they lack the need for therapeutic monitoring. Despite this, DOACs, like vitamin K antagonists, can still cause major and clinically relevant nonmajor bleeding, even when used appropriately. Drug-drug interactions (DDIs) involving the DOACs represent an important contributor to increased bleeding risk. Awareness of these DDIs and how best to address them is of critical importance in optimizing management while mitigating bleeding risk. This review provides an overview of DOAC metabolism, the most common drugs likely to contribute to DOAC DDIs, their underlying mechanisms, and how best to address them.

中文翻译：

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选择与直接口服抗凝剂的药物相互作用

美国有数百万人需要口服抗凝剂的长期治疗。几十年来，维生素 K 拮抗剂是唯一可用的口服选择。但是，它们有许多众所周知的局限性。长期以来，直接口服抗凝剂 (DOAC) 的引入一直被认为是一项重大的治疗进展，主要是因为它们不需要进行治疗监测。尽管如此，DOAC 与维生素 K 拮抗剂一样，即使使用得当，仍会导致严重的和临床相关的非大出血。涉及 DOAC 的药物相互作用 (DDI) 是导致出血风险增加的重要因素。了解这些 DDI 以及如何最好地解决它们对于优化管理和降低出血风险至关重要。本综述概述了 DOAC 代谢，